Research Article

Normative vestibulo-ocular reflex data in 6-12 year-old children using video head-impulse test


Background and Aim: The video head-impulse test (vHIT) is a useful clinical tool to measure vestibulo-ocular reflex (VOR) gain that is defined as the ratio of eye velocity to head velocity. Although normative data are available for VOR gain, most studies only report horizontal semicircular canal VOR in adults and overlooked children. Hence, this study aimed at establishing normative VOR data for 6-12 years old children.
Methods: Vestibulo-ocular reflex gain in horizontal and vertical planes was assessed on 60 healthy children without a history of balance and hearing problems using sudden, fast, and unpredictable head impulses.
Results: The mean and standard deviation of VOR gains were 0.99 (0.05), 0.98 (0.06), and 0.93 (0.06) for horizontal, anterior, and posterior canals, respectively. Gain differences between genders were not statistically significant.
Conclusion: The simplicity and tolerability of vHIT in children showed that it can be used as a screening tool to diagnose vestibular disorders in children. In addition, it was seen that mean VOR gain is greater in horizontal canal than vertical canal.

1. Rine RM. Growing evidence for balance and vestibular problems in children. Audiol Med. 2009;7(3):138-42. doi: 10.1080/16513860903181447.
2. Nandi R, Luxon LM. Development and assessment of the vestibular system. Int J Audiol. 2008;47(9):566-77. doi: 10.1080/14992020802324540.
3. Shumway-Cook A, Woollacott MH. Dynamics of pos¬tural control in the child with Down syndrome. Phys Ther. 1985;65(9):1315-22. doi: 10.1093/ptj/65.9.1315.
4. Rine RM, Cornwall G, Gan K, LoCascio C, O'Hare T, Robinson E, et al. Evidence of progressive delay of motor development in children with sensorineural hearing loss and concurrent vestibular dysfunction. Percept Mot Skills. 2000;90(3 Pt 2):1101-12. doi: 10.2466/pms.2000.90.3c.1101.
5. Leigh RJ, Brandt T. A reevaluation of the vestibulo-ocular reflex: new ideas of its purpose, properties, neural substrate, and disorders. Neurology. 1993;43(7):1288-95. doi: 10.1212/wnl.43.7.1288.
6. O'Reilly RC, Greywoode J, Morlet T, Miller F, Henley J, Church C, et al. Comprehensive vestibular and balance testing in the dizzy pediatric population. Otolaryngol Head Neck Surg. 2011;144(2):142-8. doi: 10.1177/0194599810393679.
7. Hamilton SS, Zhou G, Brodsky JR. Video head impulse testing (VHIT) in the pediatric population. Int J Pediatr Otorhinolaryngol. 2015;79(8):1283-7. doi: 10.1016/j.ijporl.2015.05.033.
8. McGarvie LA, MacDougall HG, Halmagyi GM, Burgess AM, Weber KP, Curthoys IS. The video head impulse test (vHIT) of semicircular canal function - age-dependent normative values of VOR gain in healthy subjects. Front Neurol. 2015;6:154. doi: 10.3389/fneur.2015.00154.
9. Halmagyi GM, Curthoys IS. A clinical sign of canal paresis. Arch Neurol. 1988;45(7):737-9. doi: 10.1001/archneur.1988.00520310043015.
10. Mossman B, Mossman S, Purdie G, Schneider E. Age dependent normal horizontal VOR gain of head impulse test as measured with video-oculography. J Otolaryngol Head Neck Surg. 2015;44:29. doi: 10.1186/s40463-015-0081-7.
11. D'Onofrio F. Vertical eye movements during horizontal head impulse test: a new clinical sign of superior vestibular neuritis. Acta Otorhinolaryngol Ital. 2013;33(6):418-24. PMCID: PMC3870445
12. Bartolomeo M, Biboulet R, Pierre G, Mondain M, Uziel A, Venail F. Value of the video head impulse test in assessing vestibular deficits following vestibular neuritis. Eur Arch Otorhinolaryngol. 2014;271(4):681-8. doi: 10.1007/s00405-013-2451-y.
13. Ross LM, Helminski JO. Test-retest and interrater reliability of the video head impulse test in the pediatric population. Otol Neurotol. 2016;37(5):558-63. doi: 10.1097/mao.0000000000001040.
14. Matiño-Soler E, Esteller-More E, Martin-Sanchez JC, Martinez-Sanchez JM, Perez-Fernandez N. Normative data on angular vestibulo-ocular responses in the yaw axis measured using the video head impulse test. Otol Neurotol. 2015;36(3):466-71. doi: 10.1097/mao.0000000000000661.
15. Murnane O, Mabrey H, Pearson A, Byrd S, Akin F. Normative data and test-retest reliability of the SYNAPSYS video head impulse test. J Am Acad Audiol. 2014;25(3):244-52. doi: 10.3766/jaaa.25.3.3.
16. Nyström A, Tjernström F, Magnusson M. Outward versus inward head thrusts with video-head impulse testing in normal subjects: does it matter? Otol Neurotol. 2015;36(3):e87-94. doi: 10.1097/mao.0000000000000698.
17. Hülse R, Hörmann K, Servais JJ, Hülse M, Wenzel A. Clinical experience with video Head Impulse Test in children. Int J Pediatr Otorhinolaryngol. 2015;79(8):1288-93. doi: 10.1016/j.ijporl.2015.05.034.
18. Nassif N, Balzanelli C, Redaelli de Zinis LO. Preliminary results of video head impulse testing (vHIT) in children with cochlear implants. Int J Pediatr Otorhinolaryngol. 2016;88:30-3. doi: 10.1016/j.ijporl.2016.06.034.
19. Pepaś R, Pyda-Dulewicz A, Śmiechura M, Konopka W. Application Video Head Impulse Test in the diagnosis of balance system in children. Pol Otorhino Rev. 2015;4(2):6-11. doi: 10.5604/20845308.1150794.
20. Khater AM, Afifi PO. Video head-impulse test (vHIT) in dizzy children with normal caloric responses. Int J Pediatr Otorhinolaryngol. 2016;87:172-7. doi: 10.1016/j.ijporl.2016.06.030.
21. Ulmer E, Bernard-Demanze L, Lacour M. Statistical study of normal canal deficit variation range. Measurement using the Head Impulse Test video system. Eur Ann Otorhinolaryngol Head Neck Dis. 2011;128(5):278-82. doi: 10.1016/j.anorl.2011.05.005.
22. Blödow A, Pannasch S, Walther LE. Detection of isolated covert saccades with the video head impulse test in peripheral vestibular disorders. Auris Nasus Larynx. 2013;40(4):348-51. doi: 10.1016/j.anl.2012.11.002.
23. Janky KL, Givens D. Vestibular, Visual Acuity, and Balance Outcomes in Children With Cochlear Implants: A Preliminary Report. Ear Hear. 2015;36(6):e364-72. doi: 10.1097/aud.0000000000000194.
24. Guerra Jiménez G, Pérez Fernández N. Reduction in posterior semicircular canal gain by age in video head impulse testing. Observational study. Acta Otorrinolaringol Esp. 2016;67(1):15-22. doi: 10.1016/j.otoeng.2014.10.011.
25. Naderi N, Hajiabolhassan F, Farahani S, Yazdani N, Jalaie S. Normative vestibulo-ocular reflex data in yaw and pitch axes using the video head-impulse test. Aud Vest Res. 2016;25(1):39-48.
26. Li C, Layman AJ, Geary R, Anson E, Carey JP, Ferrucci L, et al. Epidemiology of vestibulo-ocular reflex function: data from the Baltimore Longitudinal Study of Aging. Otol Neurotol. 2015;36(2):267-72. doi: 10.1097/mao.0000000000000610.
IssueVol 26 No 3 (2017) QRcode
SectionResearch Article(s)
Semicircular canal vestibulo-ocular reflex gain video head-impulse test

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Alizadeh S, Rahbar N, Ahadi M, Sameni SJ. Normative vestibulo-ocular reflex data in 6-12 year-old children using video head-impulse test. Aud Vestib Res. 2017;26(3):145-150.